People Helping People

The Environment of Health Care

by Harold Bengsch

This edition of OzarksWatch is dedicated to the proposition that our environment is a fabric of
situations and circumstances in which we live. One circumstance we have come to call "health
care." The social, emotional, and economic well being of individuals and of whole communities is
effected, for better or worse, by the nature of the health care that is available. Since I am familiar
with the circumstances of health care in southwest Missouri, this article focuses on that part of the
Ozarks.

Providing health care for the folks who live in the Ozarks has a long, rich tradition of caring,
nurturing, and compassion. In time as well as technology it ranges from early physicians making
house calls on horseback, to modern quick-response air lift vehicles equipped with space-age
lifesaving equipment. But for all the technological advances, a hundred-year evolution from horse
and buggy to high-tech has left intact that same ethic of compassion and care.

Health Care in the Ozarks

Springfield, with its "Medical Mile," is clearly the hub of medical services for the region. Major
clinics and hospitals offer a range of medical specializations and a level of diagnosis and treatment
equaled only at the largest urban medical centers of the United States. The result is patient
referrals from all over the Ozarks, and beyond.

Significant health care services are also available to Ozarkers in settings closer to their homes.
Private practitioners, both medical doctors and doctors of osteopathy, county health departments,
home health agencies, community hospitals, and long-term care facilities combine with the
available specialized care in Springfield to create an effective blend of services. Considered
separately, the elements of this union may seem quite different from one another in form and
function, yet they all focus on the common goal of providing top quality client care and service.
This wedding of a variety of health care services in communities across the Ozarks provides an
environment of care that is the envy of other rural regions of the United States.

Photo from Shiloh Museum's Bobbie Kennard Collection.

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Community Doctors

Whether medical doctors or doctors of osteopathy, small town physicians still possess the same
caring qualities of their pioneering forerunners--traits which build patient relationships in which
doctors are considered "like members of the family." Such close personal association not only
establishes a high level of confidence between doctor and patient so desirable in the practice of
good medicine, it also gives the physician an overall picture of other factors influencing the
patient's health. The benefits of providing medical care for the entire family in a comprehensive
setting has, in fact, given rise to a focused area of medicine known as "family practice." It is a
specialty very well regarded in rural areas, and many communities in the Ozarks actively recruit
new physicians with this training.

To help provide these doctors, the Lester E. Cox Medical Centers of Springfield has established a
Family Practice Residency Program in which fourteen physicians are currently being trained in the
medical treatment of family members of all ages. Physicians in this three-year residency program
receive a broad spectrum of supervised hands-on instruction and experience in major areas of
medicine including minor surgery, inpatient medical care, emergency medicine, and obstetrics and
delivery. Their training also encourages timely and appropriate referrals to medical specialists.

While in training, the residents complete a rotation in the Springfield/Greene County Health
Department. In this setting they see firsthand how local health departments provide an extension
of community health care services in interaction with community physicians and other health care
providers.

Residents in the Cox program come from Missouri, Arkansas, and surrounding states. Typically
they come from small towns, and intend to practice in the Ozarks upon completion of their
training.

County Health Departments

Children growing up in the rural Ozarks have for years had occasion to meet the county health
nurse, through personal health education in the school, childhood immunizations, or some other
facet of health service. The county health nurse continues to provide those proven services; but
today the nurse's role is greatly expanded. Duties now include child health screenings, nutrition
training and evaluation for both women and children, adult health screenings, home visits on
doctor referrals, and follow-up of communicable disease reports such as tuberculosis, measles and
other infectious illnesses.

Working in partnership with the county health nurse in most counties will be a specialist in
environmental and community sanitation. The sanitarian is trained to provide expert counsel and
guidance for residents who wish to drill a new well, build a septic tank, or solve a community
environmental problem. In addition, the sanitarian is kept busy inspecting restaurants,
campgrounds and commercial lodging establishments. With the growth of the tourist industry in
the Ozarks and its importance to our economy, helping assure safe, sanitary food and facilities is a
vital service of county health departments.

As a team, the county health nurse and sanitarian provide a powerful tool for community
physicians in determining if certain illnesses which they see in their patients have a common and,
more important, preventable cause. When this is the case, appropriate control measures can be
implemented to reduce the spread of the illness.

Photo courtesy of St. John's Regional Health Center,

Springfield, Missouri

Home Health Agencies

Needless to say, a protracted hospital stay can become very expensive. Today, Medicaid and
Medicare, and most private insurance companies, encourage the provision of health care in the
home when such care is both medically desirable and economically feasible. To this end home
health agencies provide Ozarkers valuable and beneficial services, ranging from skilled nursing
services, physical therapy, and nutrition counseling, to home aid helpers who assist with certain
domestic services. Such agencies may be housed in county health departments, in community
hospitals or, in some cases, may be freestanding entities.

Often, especially in rural counties, home health providers are themselves longtime county
residents who are well known to their clients. It is satisfying to see a return to the Ozarks tradition
of neighbor helping neighbor during a time of illness.

Community Hospitals

The Ozarks is dotted with inpatient care facilities of varying sizes. Although the sophistication of
these hospitals in terms of the surgery and diagnostic procedures performed may vary, providing
caring and compassionate service to their patients is a thread common to all of them.

Several factors make community hospitals a viable and attractive alternative to a larger, distant
regional facility. Transportation is often a critical difficulty, not only for the person being
hospitalized, but for other family members wish-lng to visit the patient. In many cases simply
being closer to home provides a psychological boost for the patient. Also, hospitalization in the
community hospital often means the patient need not change doctors and can remain in the care of
a familiar, Iongtime health care provider. The patient is afforded an emotional lift and the doctor
remains close to the patient and the family.

The existence of a hospital and a professional staff is important when a community tries to attract
new physicians. In a sense, the community hospital becomes the nucleus around which direct
health care services are built. In addition, they provide employment and attract peripheral services,
all helpful to the local economy.

When highly technical and sophisticated procedures are necessary, Springfield plays a regional
role with its larger institutions, diagnostic clinics, and multiplicity of medical specialists. But even
in big Springfield institutions, the Ozarks ethic for care and compassion is not lost.

Long-Term Care

Whenever illness and disability require long-term inpatient care, many facilities to provide it are to
be found across the Ozarks. Long-term health care is a significant part of the continuum of health
care services necessary for and available to the people of the Ozarks. The general reluctance of
families to place a loved one in a long-term care facility often is tempered, may even disappear
completely, once they see the quality of care and nurturing given the patient by the staff.

Other Services

The Ozarks region is fortunate to have the Missouri Rehabilitation Center, a major state
institution located at Mt. Vernon, Missouri. First the Missouri Tuberculosis Sanatorium, then the
Missouri Chest Hospital, its purpose has changed. With the use of powerful modern day
antibiotics, few cases of tuberculosis require the long extended bed rest and isolation necessary in
years past. Today Mt. Vernon's mission includes not only rehabilitation of people suffering from
respiratory problems, but for those with head injuries and other traumas as well. Associated with
the Missouri Rehabilitation Center is the recently-opened Gene Taylor Veterans Administration
Outpatient Clinic, serving the region's veterans.

Concerns

No reasonably informed person will hesitate to acknowledge that there are problems within our
health care system which need to be addressed. They include an aging physician population now
serving the rural Ozarks (will there be enough doctors to take their places?); community hospitals
that are operating close to the financial edge; county health departments trying to fill the gap in
health services on an antiquated and woefully inadequate tax base; an escalating population of
persons on retirement income; rapidly increasing numbers of under-insured and uninsured
workers; and increasing pressure on the environment of our beautiful yet fragile Ozarks, resulting
in conditions conducive to illness and disease.

These are not minor problems. They need our urgent attention. But our people are not strangers
to difficulties. In solving present and future problems, the caring and nurturing tradition of Ozarks
people helping people will be carried forward.

Harold Bengsch is the Director of Public Health for Springfield and Greene County, Missouri.